Sr. Manager, Credentialing

Sr. Manager, Credentialing  

Strive Health is looking for a Credentialing Senior Manager to develop, improve, and monitor the credentialing, licensing, and enrollment processes for Strive Health providers. This role oversees the internal credentialing team as well as external vendors and processes.  This position ensures compliance with the appropriate accrediting and regulatory agencies and manages the Delegated Credentialing process, including Credentialing Committee. 

Essential Functions  

• Oversees the day-to-day operations of the Credentialing team 

• Owns the credentialing policies and processes for all Strive Health clinical providers in accordance with all state and federal laws.   

• Manages the credentialing database and associated modules, ensuring accuracy of data and reporting to downstream systems. Monitors critical data for extensive analysis and report generation. 

• Oversight of the expirable process to ensure all clinical provider licenses and certificates remain current, ensuring appropriate notification prior to expiration. 

• Ensures compliance with our Delegated Credentialing agreements 

• Manages our external licensing and enrollment vendor 

• Monitors and reports turnaround times for processing of applications, with continued focus on delivery of a high-quality product, with the greatest efficiency, in the least amount of time, 

• Provides Leadership with credentialing updates as it relates to credentialing practices and services; prepares and conducts credentialing orientations and provides updates as appropriate on new policies and procedures. 

• Identifies process improvement opportunities 

• Prepares for and coordinates credentialing audits in compliance with the managed care delegated credentialing contract 

• Oversees the supervision of personnel, which includes hiring qualified candidates to expand the team, work allocation, training, promotion, enforcement of internal procedures and controls, and problem resolution; evaluates performance and makes recommendations for personnel actions; motivates employees to achieve peak productivity and performance. 

• Represents the credentialing function to internal and external customers as appropriate; makes presentations to and interacts with various internal and external customers on issues pertinent to area of specialty. 

Minimum Qualifications 

• Bachelor’s degree in business or related field and/or equivalent work experience 

• 5+ years’ experience credentialing experience preferred for a health plan and or large healthcare entity such as a hospital  

• 5+ years’ experience in a medical practice business office role required  

Preferred Qualifications 

• Knowledge of provider credentialing and its direct impact on the practice’s revenue cycle  

• Excellent computer skills including Excel, Word, and Internet use  

• Detail oriented with above average organizational skills  

• Plans and prioritizes to meet deadlines  

• Excellent customer service skills; communicates clearly and effectively  

• Experience with various clinical provider credentialing processes, as well as healthcare entity credentialing with major payers such as Medicare.  

• Familiar with credentialing platforms and CAQH requirements 

• Working knowledge of NCQA Credentialing accreditation requirements and processes  

Annual Base Salary Range:: $109,000.00 - $136,000.00